Fluency Disorders
Terms
undefined, object
copy deck
- Fluency inducing conditions
- Chorus reading, lipped speech, prolonged speech, rhythmical speech, singing, slowed speech
- Chorus reading
- reading aloud w/ someone
- lipped speech
- whispering and mouthed speech-it's because there are reduced demands
- prolonged speech
- streching words out no voicing ess neural demands may use daf (delayed auditory feedback)
- singing
- keeping voice on
- slowed speech
- not prolonged
- Stuttering cause
- Recent studies neuromotor control problem.
- Stuttering influenced
- language production-when connected speech begins temperment/biological-learning port, complex learning process, inheritance, and environment.
- factors in stuttering children
- stutter on pronouns and conjunctions, whole word repetition, and some linguistic planning problems.
- Genetics stuttering
- stuttering runs in families, genetics definitely plays a role, genetics coupled w/ enviroment, psyiological, and persons response to enviroment
- Demands on fluency
- demands on motor systems and demands on language system, demands on emotional system
- demands on motor system
- speech rate of parents, turn taking style, time pressure
- demands on language system
- demands for speech, increase parental language, language stimulation, and language therapy.
- demands on the emotional system
- punishment for stuttering, conf/unstable home, parental fear of stuttering.
- stuttering characterized
- abnormal frequency and duration of stoppages in the forward flow of speech. repition(syllables, words, and words, prolongation, and blocking (airflow and voicing)
- People who stutter
- usually aware of it, embarassed, struggle not to do it. uses abnormal physical and mental effort.
- Stutter feelings
- shame, frustration, embarassment, hostility, fear. Excitement/fear can result in repetition causing more repetition and more stuttering.
- Facts about stuttering
- onset between 2-5, 1%, 5% stutter sometime in life, M->F: under 27 mos 1:1, 1st grade 3:1, 5th grade 5:1, adults 7:1 females stutter earlier and recover more quickly.
- Recovery w/o treatment
- 50-85%
- variability and predictabilty stutter
- anticipation, consistency, adaptations, language factors. Each suggest that stuttering is no just neurophysiological it's learned.
- anticipation stuttering
- stutterer can perdict stuter when reading
- consistency
- reading consistently stutter on same word
- adaptions
- after reading passage 6x's-stutter occurs less often
- language factors
- brown's 7 grammatical factors when reading aloud.
- Core behaviors stuttering
- Involuntary-repetition, prolongations, blocks
- secondary behaviors
- learned reaction to core, two classed of 2nd-escape, avoidance, feeling and attitudes.
- prolongation
- don't happen til later can be 1/2 sec in length and still be considered prolongation. several mins in adults and children.
- types of secondary behaviors
- exist upn realization of stutter escape and avoidance.
- escape
- type of secondary behavior-terminates a stutter twitch, eye blink, head nods
- avoidance
- type of secondary behavior-stutterer anticipates stuttering substitute words.
- attitude about stutterers
- feeling pervasive in people who stutter, belief cannot talk, neg attitudes about themseves and listners, tense, crazy, fearful, and insecure.
- intellgence in stutterers
- SLIGHT difference in avg. IQ-maybe related to test situation. articats there are subtle diff. in cogntion/functions such as lang. processing, sensory motor/perception
- school performance stutterers
- stutterers perform slightly below ave. stutterers more likely be 1 grade behindlower test scores because diff. in talking and deficite in lang. skills
- Stutterers nervous
- No, both stutterers and non have high leveals of arousal whecn having to speak aloud higher levels of autonomic arousal during stutter
- Sensory motor coordination stutter
- REaction time, central autditory processing, cerbral dominance, and fluent speech of stutterers.
- stutterers reaction time
- sloer all almost all types of sense motor studies including auditory and visual stimuli.
- Central auditory processing
- synthetic sentence ID test-stutterers perform more pooly on tasks requiring audiotry discrimination of small time differences in signals
- Masking level for stutterers
- Stutterers have a harder time dectecting tone w/ presence of masking.
- cerebral dominance
- Normal-Left-speech + lang. rapid changes right-slow signals. pet scan shows increase in right when reading aloud, but left in non, severe stutterers do not activate left. diff are there even after treat.
- Stutterer brain
- decrease in left active of lang. area while increase in right, stutterers use less efficient part of brain for processing and encoding speech.
- acoustical studies problems
- lower vowel durations, slow transistions between consonants and vowels, and delayed VOT.
- Kinematic research
- measures movement of speech structures-speech structures move more slowly-slow movement causes muscle tension, neural processing delays.
- Physical development
- link between growth and neurological maturation. imbalance can inhibit maturation and develop. of front cerebral space. No proof that physical development impact stutterering
- Neurogenic Stuttering
- result of identifiable neuropathology: stroke (usually right hemisphere), head trauma, brain tumors, drug use, Tourette syndrome
- Psychogenic Stuttering
- neurotic or hysterical stuttering; psychological reaction to stress; does not disappear; begins suddenly and usually occurs later in life; long repetitions and prolongations, and tense blocks; few secondary behaviors
- Chronic Perseverative Stuttering Syndrome
- incurable/irremediable stuttering, named by Gene Cooper, fluent speech is an unrealistic goal, includes adolescents and adults; typically respond to treatment with increased fluency only to relapse shortly after completing formal treatment
- cluttering
-
sounds cluttered as though they are talking without a clear idea of what they want to say; talk too fast and jerky, run words and sentences together; may also repeat sounds, syllables, and phrases excessively; typically unaware of any difficulty; clutterers are talkative, outgoing, disinhibited; may also have academic problems in various subjects, which may or may not be severe enough to qualify for services; some may excel in certain areas, such as math
tachylalia (talk too fast), disorganized thinking, unawareness, inability to get to the point, poor syntax - Diagnosis
- process of identifying a disorder by analysis of symptoms presented; may include a study of the origin and development of the symptoms
- Differential diagnosis
- process of distinguishing between 2 similar appearing conditions by discovering a significant symptom or attribute present in one condition but not the other
- Assessment
- global appraisal of the significance and implications of diagnostic assessment; formal and informal procedures, objective and subjective procedures; also called evaluation
- Questions to be resolved by assessment:
-
Child - normally disfluent child? stutterer? is child at risk for stuttering?
Adult - nature of problem, severity of problem, extent of problem (impact), prognosis for treatment - Components of Assessment/Diagnosis
-
Background information: case history, questionnaires, tapes
-Interview: parent, adolescent, adult
-Measurement and Discription of Disfluent Behavior: speech samples (3-5 min each of conversation, monologue, and reading), frequency of disfluent speech, frequency of specific types of disfluencies (repetitions, prolongations, blocks) - measurements
- baseline frequency - percent stuttered syllables, average number of stuttered syllables per minute, average syllables per minute (speech rate)
- words per minute
- not constant, minimal rate information
- syllables per minute
- constant
- overall speech rate:
- total syllables / minutes
- total disfluency index
- stuttered syllables / total syllables
- disfluency type index
- number of disfluencies of that type / number of stuttered syllables
- Instrumental (operant) conditioning
- behavior is immediately followed by reward (or punishment)responsible for the development of secondary behaviors
- stimulus contingencies
- two things happen in a sequence
- response contingencies
- if a response follows a stimulus
- conditioning
- plays a role in development of stuttering, not in initiating stuttering classical conditioning (like Pavlov and his dogs)
- shaping
- gradually rewarding behaviors that are increasingly closer to target behavior
- Variables affecting operant conditioning
-
-strength of reward/punishment: big rewards are more effective, but punishment is better in moderation
-timing: immediately after behavior is most effective
-frequency: fixed-ratio schedule is where reward follows a certain number of responses
variable-ratio schedule is where the reward comes after varying number of responses - Anticipatory struggle theory
- stutterers interfere in some manner w/ their speech b/c of belief that speech is difficult, anticipation of sutter leads to stuttering
- capacities and demands model
- considers capacites and effect of environment. propose that children who stutter 71% genetics 30% environment.
- deterioration of fluency
- viewed as imbalance bt childs capacity and fluency dmeands placed on child from environment. environment exceeds the capacity of child.
- capacity for fluency
- motor skills, reaction time, cooridination, movement time, velocity of motor programming
- emotional maturity
- confidence and social skills
- language skills
- word retrieval, grammar form, pragmatic skills, cog. development.
- cerebral dominance normal
- allow for synch of neural impulses leading to smooth coordinated fluent speaker.
- cerebral dominance stutterer
- not established half dominance whenno dominance half each will function independent resulting in a lack of synch of neural imp thus predisposed to motor speech breakdown.
- diagnosogenic theory
- stuttering beings not in the mouth of child, but in ear. caused by parents misdiagnosis abnormal parental reaction to hesitancy in speech.
- SL development
- difficulty is more common in stutterers. stutterers score lower on SL test. age onset of 1st word and 1st sent., size of vocabe, MLU, express and recept syntax. not clear cut
- articulation differences
- research has confirme as 21/2x's more articulation disorders than in non.
- Normal fluency failure
- stress reaction disfluency, normal developmental disfluency
- stress reaction disfluency
- normal fluency failure, psychological stress/emotional disfluency is gone when stress is gone
- normal developmental disfluency
- normal fluency failure, child more disfluent at some times than others, peak of disfluency 2.6-4 yrs repeat whole words, no need for therapy.
- variables of disfluent speech
- presence of extras sounds, abnormal location and freq of pauses, deviation from typical rhythm, lack of intonation/stress, abnormal overall rate